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Purpose: This study aimed to evaluate the impact of intravitreal triamcinolone acetonide (TA) administration after peeling of idiopathic epiretinal membranes (iERM) on both anatomical and visual outcomes, utilizing the ectopic inner foveal layer (EIFL) staging scheme., Methods: In this retrospective case-control study, we analyzed 43 eyes from 43 patients diagnosed with iERM between June 2019 and December 2021. All participants were categorized into the TA or control groups based on administering intravitreal TA injection following ERM peeling. We thoroughly reviewed the clinical data, including the preoperative and postoperative best-corrected visual acuity (BCVA), central foveal thickness (CFT), and macular cube volume (VOL), with ERM stages classified according to the EIFL staging scheme., Results: The study enrolled 22 eyes in the TA and 21 in the control groups. Following a mean follow-up period of 11.07 ± 2.02 months, noteworthy improvements in EIFL stages were observed in both cohorts ( p  < 0.01), but without significant distinctions between groups. In the TA group, 63.64% of eyes demonstrated improvements in EIFL stages, while the control group exhibited 76.19% ( p  = 0.37). At the final visit, both groups experienced a noteworthy reduction in the postoperative CFT and VOL ( p  < 0.05), coupled with significant improvement in BCVA ( p  < 0.01). No substantial differences appeared between the two groups concerning BCVA, CFT, and VOL (all p  > 0.05)., Conclusions: Our study suggested that concurrent intravitreal TA injection following ERM removal did not provide additional benefits regarding anatomical and visual improvement in iERM cases classified as Stages 2 and 3., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The aim of this study was to evaluate the clinical characteristics and surgical outcomes of the epiretinal membrane foveoschisis (ERM-FS) with different morphological types., Methods: This retrospective observational study reviewed 44 consecutive ERM-FS patients who underwent ERM surgery. According to the optical coherence tomography images, ERM-FS was classified into three groups: group A, FS crossed the fovea with the foveola elevated; group B, FS located at the foveal edges with a near-normal central foveal point thickness; and group C, FS with undermined foveal edges with a near-normal central foveal point thickness., Results: There were 10 eyes in group A, 20 eyes in group B, and 14 eyes in group C. Preoperatively, eyes in group A had the best best-corrected visual acuity (BCVA), the thickest central foveal point thickness, and the highest ellipsoid zone (EZ) intact rate among the three groups. After surgery, a resolution of foveoschisis was observed in 40.0%, 45.0%, and 50.0% of the eyes in group A, group B, and group C (p = 0.928), respectively. BCVA was significantly improved postoperatively. Although there was no significant difference in BCVA among the three groups at 1 month postoperatively, BCVA of group A was the best at 4 and 10 months. Correlation analysis indicated that the type of ERM-FS, baseline BCVA, central foveal point thickness, and postoperative EZ continuity (all p &lt; 0.05) were important factors for the final BCVA., Conclusions: The damage to the retinal structure and visual function was milder in group A ERM-FS. Our study emphasized the necessity of OCT-based subtyping in patients with ERM-FS., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Purpose: To evaluate the change in the fovea's postoperative location after successful pars plana vitrectomy with combined epiretinal and internal limiting membrane peeling in patients with idiopathic epiretinal membranes (iERMs)., Methods: In this prospective study 32 eyes of 32 patients with iERMs were followed from baseline before until 3 months after surgery. Study measures included 4-m Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, enhanced-depth imaging-optical coherence tomography, and intraoperative fundus photographs. Foveal movement was assessed by measuring the change in the papillofoveal distance (∆PFD)., Results: Mean ∆PFD in the study eye was -124 µm (±138) and -272 µm (±213) one day and 3 months after surgery, respectively. Mean ∆PFD after 3 months was greater in the study than in the fellow eye (P < 0.001). ∆PFD at Month 3 did not correlate with the internal limiting membrane area peeled (P = 0.78)., Conclusion: Foveal movement starts immediately after surgery and causes a statistically significant reduction in PFD after uneventful macular pucker surgery. ∆PFD correlates statistically significantly with baseline best-corrected visual acuity and baseline central retinal thickness. The internal limiting membrane peeling size had no significant effect on the amount of postoperative foveal dislocation.

Differences in the pathogenesis and clinical characteristics between lamellar macular hole (LMH) with and without LMH-associated epiretinal proliferation (LHEP) can have surgical implications. This study investigated the effects of treating LHEP by foveolar internal limiting membrane (ILM) non-peeling and epiretinal proliferative (EP) tissue repositioning on visual acuity and foveolar architecture. Consecutive patients with LHEP treated at our institution were enrolled. The eyes were divided into a conventional total ILM peeling group (group 1, n = 11) and a foveolar ILM non-peeling group (group 2, n = 22). In group 2, a doughnut-shaped ILM was peeled, leaving a 400-μm-diameter ILM without elevated margin over the foveola after EP tissue repositioning. The EP tissue was elevated, trimmed, and inverted into the LMH. Postoperatively, the LMH was sealed in all eyes in group 2, with significantly better best-corrected visual acuity (-0.26 vs -0.10 logMAR; p = 0.002). A smaller retinal defect (p = 0.003), a more restored ellipsoid zone (p = 0.002), and a more smooth foveal depression (p < 0.001) were achieved in group 2. Foveolar ILM non-peeling and EP tissue repositioning sealed the LMH, released the tangential traction, and achieved better visual acuity. The presumed foveolar architecture may be reconstructed surgically. LMH with LHEP could have a combined degenerative and tractional mechanism.

Background and Objective: To show the morphologic changes on the foveal avascular zone (FAZ) in patients with epiretinal membrane (ERM) using optical coherence tomography angiography (OCTA) and to demonstrate the correlation between distortion of FAZ and features of the ERM., Patients and Methods: FAZ eccentricity index (longest diameter of FAZ/shortest diameter of FAZ) was measured in 52 patients with ERM and compared with 27 healthy subjects' values. The density of the ERM was quantified using a grading scale (0-3) on multicolor scanning laser images, and spectral-domain OCT characteristics of the eyes were assessed., Results: Of the 52 eyes with ERM, 31 eyes (59.61%) showed some foveal remodeling, including full (13.46%) or partial (30.76%) apparent vascularization of FAZ, presence of a vessel crossing the fovea (9.61%), and horizontal or vertical elongation of FAZ (5.76%). The mean FAZ eccentricity index was 0.84 ± 0.46 (range: 0.0-1.86) in eyes with ERM and 0.98 ± 0.07 (range: 0.96-1.02) in the control subjects, respectively (P = .02). There was a negative significant correlation between FAZ eccentricity index and central macular thickness (P = .04)., Conclusions: Thickening of the central fovea leads to foveal remodeling in ERM eyes, and OCTA enables the visualization of architectural FAZ changes. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:295-301.]., (Copyright 2019, SLACK Incorporated.)

Purpose: To describe the functional and anatomical outcomes of pars plana vitrectomy with epiretinal membrane and internal limiting membrane peel in eyes with and without ectopic inner foveal layers (EIFLs)., Methods: In this retrospective multicenter study, patients diagnosed with idiopathic epiretinal membranes who underwent pars plana vitrectomy with epiretinal membrane and internal limiting membrane peel were enrolled, with a minimum follow-up of 12 months. Preoperative and postoperative spectral domain optical coherence tomography scans were qualitatively and quantitatively evaluated. The association of the EIFL and other spectral domain optical coherence tomography parameters with preoperative and postoperative best-corrected visual acuity (BCVA) was analyzed., Results: One hundred eleven eyes of 107 patients were included. Preoperatively, the EIFLs were present in 56 of 111 eyes (50.4%). The presence of EIFL was significantly associated with lower preoperative and postoperative BCVA (P < 0.001). Ectopic inner foveal layer thickness was negatively correlated with preoperative BCVA (r = 0.58, P < 0.001). Postoperatively, the EIFL persisted in 51 of 56 eyes (91%) with Stage 3 and 4 epiretinal membranes. Ectopic inner foveal layer thickness decreased significantly after surgery (P < 0.001), but postoperative EIFL thinning had no direct effect on postoperative change in BCVA. At 12 months from surgery, EIFL thickness maintained a significant negative correlation with BCVA (r = 0.55, P < 0.001)., Conclusion: The presence of EIFL should be considered a negative prognostic factor for postoperative anatomical and functional recovery.

Background and Objective: To compare the surgical outcomes of epiretinal membrane (ERM) treatment between eyes with and without an ectopic inner foveal layer (EIFL)., Patients and Methods: Seventy-seven ERM eyes of 76 consecutive patients were investigated retrospectively. Optical coherence tomography examinations and best-corrected visual acuity (BCVA) measurements were performed before and at 6 and 12 months after vitrectomy., Results: In both eyes with and without an EIFL, the BCVAs at 6 and 12 months after vitrectomy were significantly better than those before vitrectomy (P < .05), whereas the BCVAs 6 and 12 months after vitrectomy were significantly better in eyes without an EIFL than in those with an EIFL (P = .014 and P = .019, respectively)., Conclusions: Vitrectomy may be effective in improving visual acuity in eyes with ERMs with and without an EIFL. However, ERM surgery may be desirable before EIFL development to obtain a better prognosis. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:838-845.]., (Copyright 2018, SLACK Incorporated.)

Backround and Objective: Patients with idiopathic epiretinal membranes (ERMs) and visual acuity of 20/40 or better are often monitored until vision or associated symptoms worsen to affect everyday living. This study looks at the rate of progression to surgery and the characteristics associated with progression., Patients and Methods: This study was a retrospective, consecutive case series of patients with newly diagnosed idiopathic ERMs who were referred to the Retina Service at the Ophthalmic Consultants of Boston between January 2009 and May 2015 with 20/40 or better visual acuity. Surgical membrane peel was typically offered when vision worsened to 20/50 or beyond and/or when patients could not tolerate symptoms attributable to the ERM. All eligible eyes were categorized by baseline optical coherence tomography (OCT) morphology into normal, mild or incomplete, or complete loss of foveal contour. Visual acuities were averaged through conversion to logMAR. Kaplan-Meier survival curves for progression to surgical membrane peel were calculated. The main outcome measure was progression to surgical intervention., Results: The study included 201 eyes from 170 patients; 29.8% had normal, 18.9% had mild loss, and 51.2% had complete loss of foveal contour on baseline OCT. Overall, 13% of eyes progressed to surgery at 7 years. However, only 5% of eyes with normal foveal contour progressed to surgery by 5.5 years, whereas 17% with incomplete and 16% with complete loss of foveal contour progressed to surgery at 6 and 7 years, respectively. Eyes with worse foveal contours progressed to surgery more rapidly., Conclusion: A minority of patients with newly diagnosed ERMs who did not need surgical intervention progressed to needing surgery at 7 years with the rate and speed of progression dependent on baseline OCT morphology. These statistics can be useful in counseling patients who are deciding between watchful waiting and surgical intervention. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S18-S22.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To explore the association among the metamorphopsia identified by Amsler grid test, orientation discrimination threshold (ODT), and retinal layer thickness in patients with idiopathic epiretinal membrane (ERM)., Methods: A total of 48 ERM patients were divided into a fovea-spared (FS) group (n = 12) and a fovea-involved (FI) group (n = 36). A total of 23 visually normal people served as controls. Metamorphopsia was first assessed with an Amsler grid. The ODT was quantified with groups of briefly displayed short line segments. Inner and outer retinal layer thickness (IRLT and ORLT) was measured with spectral domain optical coherence tomography., Results: A total of 12 patients with ERM (1 in FS and 11 in FI) reported abnormalities in the Amsler grid test. The ODT values were significantly elevated in patients in both FS (7.48 ± 1.94°, p < 0.001) and FI groups (10.14 ± 2.28°, p < 0.001) when compared to normal (4.22 ± 0.80). Receiver operating characteristic (ROC) analyses of ODT to distinguish Amsler positive and negative patients yielded an area under the curve (AUC) of 0.829. The IRLT was significantly thicker (386.6 ± 95.1 µm vs. 127.5 ± 17.6 in normal) and ORLT were significantly thinner (88.11 ± 8.24 vs. 94.39 ± 5.66 in normal) in the FI group. ROC analyses to distinguish Amsler positive and negative patients yield an AUC of 0.917 using IRLT and 0.719 using ORLT. ODT correlated tightly with the thicker IRLT in both the FS and FI groups, and with the thinner ORLT in the FI group., Conclusions: In patients with ERM, ODT reflects functional changes that are not detected by the Amsler grid test and correlates with changes in inner retina layer thickness well.

Background/objectives: To evaluate the relationship between the presence of ectopic inner foveal layers (EIFL), choroidal thickness, and visual acuity (VA) in patients with epiretinal membranes (ERM) staged by spectral-domain optical coherence tomography (SD-OCT)., Subjects/methods: A total of 242 eyes of 121 patients with unilateral idiopathic ERM were prospectively evaluated. ERM stages were defined based on the SD-OCT staging system as stage 1: negligible morphological or anatomical disruption, retinal layers, and foveal pit are identified; stage 2: characteristic stretching of the outer nuclear layer, absence of foveal depression, retinal layers are identified; stage 3: continuous EIFL crossing the central foveal area, absence of foveal depression, retinal layers are identified; and stage 4: anatomical disruption of the fovea, continuous EIFL crossing the entire foveal area, retinal layers are distorted., Results: Of 121 eyes with ERM, 23.1% had stage 1, 26.5% had stage 2, 39.7% had stage 3, and 10.7% had stage 4 disease. VA was better in eyes with stage 1 or 2 ERM than stage 3 or 4 ERM (p < 0.001). VA in logMAR was positively correlated with central foveal thickness (r = 0.557, p < 0.001) and EIFL thickness (r = 0.526, p < 0.001), but not with an outer nuclear layer thickness (r = 0.233, p = 0.123). In multivariate analysis, the presence of EIFL was an independent predictor of VA in eyes with ERM (p < 0.001). The presence and stage of ERM did not have a significant effect on choroidal thickness (p > 0.05)., Conclusions: The SD-OCT staging system according to the presence of EIFL is effective for grading retinal damage and visual loss in eyes with ERM.

Purpose: To investigate the tractional alterations of the central bouquet (CB) in idiopathic epiretinal membranes (ERMs)., Design: Retrospective, consecutive, observational case series., Methods: ERMs were classified according to a 4-stage grading system. The CB was defined as a circular area of approximately 100 μm composed of densely packed cones (and Müller cells) in the central fovea. Tractional abnormalities of the CB were identified with spectral-domain optical coherence tomography. Ex vivo histopathologic analysis was performed., Results: In this study 263 eyes with ERMs were included. Mean follow-up was 21.2 ± 16.7 months. At baseline, tractional abnormalities of the CB were diagnosed in 58 out of 263 eyes (22%) and divided into 3 categories: cotton ball sign (defined as a fuzzy hyperreflective area between the ellipsoid zone and the interdigitation zone in the central fovea), foveolar detachment, and acquired vitelliform lesion. The presence of ectopic inner foveal layers was negatively correlated with the presence of CB tractional abnormalities (P = .002). Visual acuity was highest in association with the cotton ball sign and lowest in the acquired vitelliform lesion group. Sequential morphologic progression was identified in 7 eyes. Ex vivo histopathologic analysis illustrated characteristic staining patterns supporting a potential mechanism of traction by Müller cells in the CB., Conclusions: The cotton ball sign, foveolar detachment, and acquired vitelliform lesion may comprise a continuum in the same clinical spectrum and may represent subsequent stages of CB abnormalities. Foveal Müller cells may play an integral role in the transmission of mechanical forces to the central foveal cones., (Published by Elsevier Inc.)

Purpose: To quantify the extent and depth of distortion of the foveal capillary architecture due to traction of an idiopathic epiretinal membrane (ERM) using optical coherence tomography angiography (OCT-A)., Methods: Multimodal imaging including OCT-A (Angiovue, Optovue) was performed in 42 eyes with idiopathic ERM (72.4 years ±6.8). Best corrected visual acuity (BCVA), OCT-A vessel density of the foveal (VDfo) and parafoveal (VDp) region were assessed. Based on 6 × 6-mm 2 OCT-A images, a macular vessel density ratio (MVR = VDfo/VDp) was calculated for the superficial (s), deep (d) and full-thickness (f) slabs to assess a depth-resolved, non-invasive evaluation of foveal distortion. The acquired data were subdivided in a patient group with mild and significant BCVA reduction due to ERM. Data was compared to age-matched healthy controls., Results: In all three slabs, MVR was significantly smaller in the control group in comparison with the ERM group: MVRs: 0.63 ± 0.1 vs 0.83 ± 0.1 (p > 0.001); MVRd: 0.60 ± 0.1 vs 0.73 ± 0.1 (p < 0.001); MVRf: 0.68 ± 0.1 vs 0.82 ± 0.1 (p < 0.001). Group 1 (BCVA <0.4 LogMar) showed a significantly higher MVR in comparison with the control group in the superficial plexus only: MVRs: 0.64 ± 0.1 vs 0.78 ± 0.1 (p < 0.001); MVRd: 0.60 ± 0.1 vs 0.65 ± 0.2 (p = 0.3); MVRf: 0.68 ± 0.1 vs 0.77 ± 0.1 (p = 0.01). However, group 2 (BCVA > = 0.4 LogMar) showed a significantly higher MVR in all three slabs: MVRs: 0.64 ± 0.1 vs 0.86 ± 0.1 (p < 0.001); MVRd: 0.60 ± 0.1 vs 0.77 ± 0.2 (p < 0.001); MVRf: 0.68 ± 0.1 vs 0.85 ± 0.1 (p < 0.001)., Conclusion: Assessing MVR using OCT-A may serve as a tool to quantify the extent and depth of distortion of the foveal capillary architecture due to traction of ERM. BCVA reduction appears to be associated with extent and depth of distortion.

Purpose: To describe the 2-year functional and anatomical outcomes in patients operated on for combined cataract and idiopathic epiretinal membrane (ERM) and to study the relationship between best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) throughout the follow-up., Methods: This retrospective observational case series included 72 eyes operated on for combined cataract and idiopathic ERM. They were followed with clinical and SD-OCT examinations preoperatively and 1, 6, 12, and 24 months after surgery. Foveolar thickness (FT), photoreceptor status and morphological parameters were assessed., Results: BCVA and FT substantially improved at 24 months. Postoperatively, no significant improvement was observed beyond 6 months for BCVA and 12 months for FT. Outer limiting membrane and inner and outer segment junction disruption scores were well correlated with BCVA both pre- and postoperatively, and significant visual improvement was demonstrated in each subgroup except in those with the highest scores. FT was correlated with BCVA only from 6 to 24 months postoperatively., Conclusion: After combined cataract and idiopathic ERM surgery, BCVA and FT improved rapidly. Most functional and anatomical recovery took place within the first 6 months, but this did not preclude late improvement, in particular in patients with the most disorganized photoreceptor layers. At each time point, the amount of photoreceptor damage seemed closely correlated with visual acuity, but concerning FT, this relationship remains questionable., (© 2016 S. Karger AG, Basel.)

Background and Objective: The aim of this study was to examine the quality of intraoperative visualization of the posterior hyaloid, epiretinal membrane (ERM), inner limiting membrane (ILM), and hyporeflective subfoveal zone with a commercially available, microscope-integrated spectral-domain OCT setup (mi-SD-OCT) (Rescan 700; Carl Zeiss Meditec AG, Germany)., Patients and Methods: Twenty patients prospectively scheduled for pars plana vitrectomy with membrane peeling due to an idiopathic ERM were included. Standard 23-gauge, three-port pars plana vitrectomy with membrane peeling and staining of the ERM with a trypan blue-based chromovitrectomy dye was performed in all cases. Intraoperative SD-OCT was performed before and after peeling and visualization of the posterior hyaloid, ERM, ILM, and presence of subfoveal hyporeflective zones were examined. OCT follow-ups were performed 2 days and 3 months after surgery. The study was approved by the local ethics committee of the city of Vienna., Results: Successful intraoperative visualization of ERM by mi-SD-OCT was possible in all cases. The posterior hyaloid and ILM could not be seen in the mi-SD-OCT scans, whereas an intraoperative subfoveal hyporeflective zone presented in 35% of cases. In 12.5% an independent subfoveal hyporeflective zone presented postoperatively. Visual acuity improved in 93.8% of patients after surgery., Conclusion: mi-SD-OCT appears to be a valuable tool for intraoperative visualization of the ERM and offers immediate visualization of retinal anatomy during peeling. Therefore, it adds to the understanding of intraoperative traumatic changes due to the peeling procedure., (Copyright 2016, SLACK Incorporated.)

Purpose: We evaluated the change in foveal contour in eyes with idiopathic epiretinal membrane (ERM) before and four months following pars plana vitrectomy with internal limiting and epiretinal membrane peeling, and correlated foveal contour with best corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters., Methods: Retrospective chart review of consecutive patients undergoing surgery with pre- and postoperative OCT. Foveal contour grading was devised according to the thickness of the fovea relative to the surrounding macula from OCT radial line scans: Grade 0, foveal depression relative to surrounding macula; Grade 1, relative flatness; and Grade 2, fovea thicker than surrounding macula. Baseline and follow-up grades were compared for change and correlated with BCVA, central retinal thickness (CRT), central subfield thickness (CST), central subfield volume (CSV), and integrity of the ellipsoid zone (EZ)., Results: Among 41 eyes of 41 patients, mean follow-up was 125 days. No eyes were Grade 0 at baseline; 7 of 41 eyes were Grade 0 at follow-up. Baseline Grade 1 eyes improved CRT (P < 0.001), CST (P < 0.001), CSV (P = 0.002), and BCVA (P = 0.022). Baseline Grade 2 eyes improved CRT (P < 0.001), CST (P < 0.001), and CSV (P < 0.001), but not BCVA (P = 0.369)., Conclusions: We developed a novel foveal contour grading method to assess retinal contour in ERM eyes before and after surgery. In eyes with ERM and no foveal depression, the majority did not regain foveal depression following surgery even though retinal thickness improved., (Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.)

Purpose: To evaluate contrast sensitivity (CS) in patients with epiretinal membrane (ERM) following vitrectomy and to investigate the relationship between CS and foveal microstructures with spectral-domain optical coherence tomography (SD-OCT)., Methods: Thirty-one eyes of 31 patients with ERM were included. We examined CS with a CSV-1000E chart, a logMAR best-corrected visual acuity (BCVA), and foveal microstructure by using SD-OCT before and at 6 months after surgery. From the CS data, the area under the log contrast sensitivity function (AULCSF) was calculated. Based on the OCT images, we quantified the mean thickness of the ganglion cell layer (GCL), the inner nuclear layer (INL), and the outer retinal layer (outer nuclear layer and outer plexiform layer [ONL+OPL]). The status of the photoreceptor inner and outer segment junction (IS/OS) and external limiting membrane (ELM) was also evaluated., Results: Vitrectomy significantly improved logMAR BCVA and AULCSF. Even in patients with poor improvement of visual acuity (changes in logMAR BCVA by surgery was ≤0.2), postoperative AULCSF significantly increased by treatment (P < 0.05). Postoperative AULCSF showed a significant correlation with preoperative (P < 0.05) and postoperative (P < 0.05) ONL+OPL thickness, whereas other parameters were not relevant. Postoperative logMAR BCVA significantly correlated with postoperative status of IS/OS (P < 0.05) and preoperative ONL+OPL thickness (P < 0.05)., Conclusions: In patients with ERM, CS improved even though their visual acuity did not recover significantly by vitrectomy. CS was associated with the thickness of outer retinal layer., (Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.)

Purpose: To determine whether there is a significant correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for epiretinal membrane (ERM) removal., Methods: This was a retrospective, interventional case series. Forty-six eyes of 45 patients with an ERM underwent vitrectomy. The foveal area was examined by spectral-domain-optical coherence tomography (SD-OCT) preoperatively and postoperatively. The correlation between the length of the photoreceptor cone outer segment tips (COST) line defect, the inner segment/outer segment junction (IS/OS) line defect, the external limiting membrane (ELM) line defect, and the BCVA was determined., Results: The length of the COST line defect was significantly correlated with the BCVA at postoperative 1, 3, 6, 9, and 12 months (P < 0.001 for all). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of COST line defect (P < 0.001) but not with the IS/OS line and ELM line defects for up to 6 months. The preoperative length of the COST line defect was significantly correlated with the postoperative BCVA at 12 months (P = 0.005), but the lengths of the IS/OS line defect and ELM line defect were not. The factor that best predicted the postoperative BCVA was the length of the preoperative COST line defect (P = 0.04) but not the preoperative BCVA (P = 0.69)., Conclusions: The recovery of the foveal COST line defect is correlated with the BCVA after ERM surgery. The length of the preoperative COST line defect can predict the potential foveal function. (ClinicalTrials.gov number, NCT01549249.).

Objective: To determine the relationship between the morphology of the fovea and visual acuity in patients with an untreated idiopathic epiretinal membrane (ERM)., Methods: We examined 52 eyes of 45 patients diagnosed with an ERM. The morphology of the foveal area was determined by spectral-domain optical coherence tomography. The relationships between the best-corrected visual acuity (BCVA) and 8 optical coherence tomography features, central retinal thickness, cone outer segment tip (COST) line, photoreceptor inner/outer segment (IS/OS) junction line, foveal bulge of the IS/OS line, external limiting membrane, inner limiting membrane, foveal pit, and ERM over the foveal center, were evaluated., Results: Multiple regression analysis showed that intact COST line, IS/OS junction line, and external limiting membrane independently and significantly contributed to the BCVA. The standardized partial regression coefficient β was 0.415 for the COST line, 0.287 for the IS/OS junction line, and 0.247 for the external limiting membrane. However, the other features, eg, foveal bulge, inner limiting membrane, foveal pit, and ERM, were not significantly associated with the BCVA. The central retinal thickness was significantly correlated with the BCVA (r2=0.274; P< .01)., Conclusions: At an early stage of an ERM, only the photoreceptor structures are significantly associated with the BCVA, and the appearance of the COST line was most highly associated. Detailed examinations of the photoreceptor structures using optical coherence tomography may help find photoreceptor dysfunction in cases of idiopathic ERM.

Purpose: To investigate the relationship between the severity of metamorphopsia and the foveal microstructure measured with spectral-domain optical coherence tomography (SD-OCT) in patients with epiretinal membrane (ERM)., Methods: This study included 48 eyes of 48 patients with idiopathic ERM and 18 age-matched normal controls. We examined the logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA) and the severity of metamorphopsia using M-CHARTS. Central foveal thickness (CFT), central retinal thickness at the fovea (CRT-1mm) and parafovea (CRT-3mm), and macular volume (MV) were measured with SD-OCT software. Based on the obtained OCT image, we divided the 1.0 × 1.0-mm area centered on the fovea into nine sections and quantified the following parameters using an image-processing program: mean thickness of the ganglion cell layer (GCL), inner nuclear layer (INL), and outer retinal layer (ONL+OPL: outer nuclear layer and outer plexiform layer), the degree of the photoreceptor inner and outer segment junction (IS/OS), and external limiting membrane (ELM) disruption., Results: CFT, CRT-1mm, CRT-3mm, MV, mean GCL, INL, and ONL+OPL thickness were significantly larger in patients with ERM than in normal controls. Multiple regression analysis revealed that the severity of metamorphopsia was significantly related to the mean INL thickness (P < 0.0001). LogMAR BCVA had a significant correlation with the degree of IS/OS disruption (P < 0.05), whereas other parameters were not relevant., Conclusions: In patients with idiopathic ERM, the degree of metamorphopsia is associated with INL thickness, and IS/OS status influences visual acuity.

Purpose: To study the relationship between foveal sensitivity and visual acuity in eyes with macular disorders exhibiting macular thickening., Methods: We studied the relationship between foveal sensitivity, obtained as the "foveal threshold" by use of Humphrey perimetry, and best-corrected visual acuity, converted to the logarithm of the minimum angle of resolution (logMAR), for 117 eyes with epiretinal membrane (ERM), 197 eyes with retinal vein occlusion associated with macular edema (RVOME), and 158 eyes with central serous chorioretinopathy (CSC)., Results: Foveal sensitivity and logMAR correlated significantly for the eyes with ERM, RVOME, and CSC. Although mean foveal sensitivity was no different among the three diseases, mean logMAR was lower in eyes with CSC, i.e., visual acuity was better, than in those with ERM or RVOME (P < 0.001)., Conclusions: Light sense (foveal sensitivity) is related to spatial resolution (logMAR) at the center of the fovea, in eyes with ERM, RVOME, and CSC at different strengths depending on the disease. Less pronounced reduction of visual acuity compared with foveal sensitivity in eyes with CSC could explain the tendency of these patients to complain of dimness rather than acuity loss.

Purpose: To investigate eccentric fixation (EF) in full-thickness macular hole (FTMH) and epiretinal membrane (ERM) and its relationship to photoreceptor integrity., Methods: The amount of EF during spectral domain optical coherence tomography scanning was determined as the distance between the scan center and the foveal center. We investigated the difference in reflectivity of the photoreceptor inner segment/outer segment (IS/OS) junction at the scan center and the foveal center., Results: The amount of EF was significantly greater in preoperative FTMH (median, 209 μm; interquartile range [IQR], 146 μm, 367 μm), postoperative FTMH (median, 138 μm; IQR, 95 μm, 461 μm), preoperative ERM (median, 210 μm; IQR, 151 μm, 308 μm), and after removal of ERM (median, 129 μm; IQR, 72 μm, 175 μm) than normal eyes (median, 67 μm; IQR, 47 μm, 101 μm). Abnormal EF was more frequently observed in eyes with greater inner segment/outer segment reflectivity at the scan center than at the foveal center., Conclusions: Fixation during the spectral domain optical coherence tomography scanning was frequently eccentric in FTMH and ERM and might be dependent on photoreceptor integrity.

Purpose: To evaluate the functional changes in various morphologic types of idiopathic epiretinal membrane (ERM) by multifocal electroretinography (mfERG) and spectral-domain optical coherence tomography (SD-OCT)., Methods: All patients (n = 71) with unilateral idiopathic ERM underwent complete ophthalmologic examination, including measurements of best-corrected visual acuity (BCVA), SD-OCT, and mfERG for both eyes. To classify idiopathic ERM by subtype, the morphologic characteristics of the foveal area on representative scanned images were assessed. The five subtypes by foveal SD-OCT morphology included fovea-attached ERM with outer retinal thickening and minimal inner retinal change (Group 1A), outer retinal inward projection and inner retinal thickening (Group 1B), and prominent thickening of inner retinal layer (Group 1C) and foveal sparing ERM with formation of macular pseudohole (Group 2A) and with schisislike, intraretinal splitting (Group 2B)., Results: On mfERG, P1 amplitude density in the central ring (R1) and inter-eye (affected eye/fellow eye) response ratio of P1 amplitude density in R1 differed significantly among five groups (P = 0.032 and P = 0.022, respectively). In Group 1 patients, central subfield thickness (CST) and inner retinal layer thickness (IRT) on SD-OCT were strongly correlated with BCVA and P1 amplitude density in R1. A receiver operating characteristic (ROC) curve analysis showed that IRT had high predictive accuracy in distinguishing Groups 1A and 1B (area under the ROC curve [AUROC] = 0.966) and Groups 1B and 1C (AUROC = 1.000)., Conclusions: Multifocal electroretinography can be used to investigate the pathophysiology of ERM and to evaluate the degree of functional demise in the fovea on SD-OCT.

Purpose: The purpose of this study was to examine the functional and structural correlates of severe foveal dystopia in patients with epiretinal membranes., Methods: For this retrospective study of 29 eyes with epiretinal membrane, we identified 7 eyes that had severe foveal dystopia (defined as fovea located >200 μm from its expected location) and followed the direction and rate of foveal movement pre- and postoperatively., Results: Epiretinal membrane traction caused the fovea to move preoperatively at a rate of 275 μm/month from its anatomical location in 2 patients. The final preoperative foveal location was, on average, 1,217 ± 683 μm away from its expected location. Postoperatively, foveal movement toward its expected location was largest during the first month after surgery (mean = 547 ± 340 μm) and slowed down until the final follow-up position was achieved (mean = 301 ± 131 μm). Overall, the fovea moved a total of 848 ± 445 μm, allowing the fovea to correct only 32.8 ± 22.1% of the total displacement from its expected location. A univariate regression model confirmed a linear relationship between preoperative visual acuity and preoperative foveal distance from its expected anatomical location with an R of 0.759 (P = 0.0107)., Conclusion: The extent of tractional foveal dystopia correlates with decreased visual acuity. Although all patients experienced functional and anatomical improvements with surgery, long-standing or severe foveal dystopia may be associated with permanent structural changes that limit functional outcome. Cases with extreme degrees of foveal dystopia may benefit from early intervention to prevent irreversible structural and functional changes.

Purpose: To correlate the postoperative visual outcome with the spectral-domain optical coherence tomography (SD-OCT) findings in the fovea after successful rhegmatogenous retinal detachment repair. Cross-sectional, observational study., Methods: Thirty-five patients with preoperative macula-on rhegmatogenous retinal detachment (12 eyes) and macula-off rhegmatogenous retinal detachment (23 eyes) who underwent scleral buckling surgery for primary rhegmatogenous retinal detachment were recruited. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity measurement, microperimetry, and SD-OCT examination were performed on the same day. Foveal center retinal thickness, central 1-mm subfield thickness, and outer nuclear layer thickness were measured using SD-OCT. The presence or absence of epiretinal membrane, intraretinal fluid, and subretinal fluid was assessed. The status of the external limiting membrane, inner/outer segment junction, and intermediate line was also evaluated and judged as disrupted or complete. The correlations between SD-OCT findings and either postoperative best-corrected visual acuity or retinal sensitivities for central 12° were analyzed., Results: The outer nuclear layer thickness was the only significant SD-OCT retinal measurement strongly correlated with both postoperative best-corrected visual acuity (r = 0.61; P < 0.001) and retinal sensitivities for central 12° (r = 0.53; P = 0.001). Among the SD-OCT imaging findings, status of the external limiting membrane, inner/outer segment junction, and intermediate line and the presence of intraretinal fluid showed a significantly high correlation either with best-corrected visual acuity outcome (r = -0.60; P < 0.001, r = -0.63; P < 0.001, r = -0.66; P < 0.001, and r = -0.50; P = 0.002, respectively) or with postoperative retinal sensitivities (r = -0.59; P < 0.001, r = -0.61; P < 0.001, r = -0.66; P < 0.001, r = -0.50; P = 0.002, respectively). Multivariate analysis showed that the outer nuclear layer thickness and the status of the intermediate line were the most important predictors of visual outcome (P < 0.001 and P < 0.001, respectively)., Conclusion: This study showed that not only the status of the external limiting membrane and the inner/outer segment junction but also the integrity of the intermediate line and the outer nuclear layer thickness changes may be important predictors of postoperative visual outcome after anatomically successful rhegmatogenous retinal detachment repair.

Purpose: To characterize subfoveal changes in patients with longstanding epiretinal membranes (ERM)., Design: Retrospective study., Methods: Analysis of 123 eyes of 123 consecutive patients who underwent surgery for ERM at the Columbia University Medical Center by a single surgeon (S.C.). Eyes were split into 2 groups: those with a preoperative yellow pigmented foveal spot and those without. The latter group was considered the control group. The primary outcome measures were logarithm of the minimum angle of resolution (logMAR) visual acuity at postoperative months 1 and 3 compared with baseline. Fundus photography, optical coherence tomography (OCT), and autofluorescence images were analyzed., Results: We identified 9 eyes with a yellow pigmented spot. All of these eyes exhibited OCT evidence of outer retinal disorganization and hypoautofluorescence. The mean duration of symptoms prior to surgery in these patients was 53 months. The mean duration of symptoms in the control group was 10.7 months. Mean Snellen acuities of the control vs yellow pucker groups were 20/59.7 vs 20/83.5 (P = .041) at baseline; 20/43.3 vs 20/64.8 (P = .006) at postoperative month 1; and 20/34.2 vs 20/50.3 (P = .011) at postoperative month 3. The logMAR magnitude of visual improvement for the yellow pucker vs control groups was not statistically different at either months 1 or 3. Central macular thickness on OCT of patients with yellow pucker decreased from a mean 495 to 395 microns (P = .041)., Conclusions: A characteristic yellow macular spot associated with ERM appears to be a sign of chronicity. OCT demonstrates outer retinal disorganization. This feature may portend a worse postoperative visual prognosis.

Purpose: To evaluate the surgical outcome of vitrectomy and foveal thickness before and after vitrectomy for idiopathic epiretinal membranes., Subjects and Methods: Twenty-three eyes of 21 patients with idiopathic epiretinal membranes were analyzed. The mean follow-up period was 17.8 months. In 16 eyes of 14 patients, foveal thickness was measured by optical coherence tomography (OCT)., Results: Preoperative visual acuity ranged from 0.1 to 0.7. Postoperatively, 17 eyes achieved a final visual acuity of 1.0 or better, and 21 eyes achieved 0.5 or better. Preoperative foveal thickness ranged from 205 to 575 microns (mean +/- standard deviation, 409.9 +/- 103.3 microns). Postoperatively, mean foveal thickness was 347.7 +/- 106.0 microns (1 week follow up), 338.6 +/- 103.7 microns (2 months), 304.6 +/- 97.0 microns (6 months), and 274.3 +/- 78.7 microns (1 year). There was a weak negative correlation between visual acuity and foveal thickness., Conclusion: Visual acuity improves significantly after surgery. OCT is useful for idiopathic epiretinal membrane surgery.

Background/aims: Eyes with epiretinal membranes (ERMs) often have alterations of retinal vessels. The authors studied perifoveal microcirculation in eyes with epiretinal membranes (ERMs) using scanning laser ophthalmoscope (SLO) fluorescein angiography., Methods: Mean capillary blood flow velocity (CFV) was measured as an index of perifoveal microcirculation by SLO fluorescein angiography in 26 eyes with ERMs (19 eyes with idiopathic epiretinal membranes, seven eyes with epiretinal membranes after retinal detachment surgery) before and 6 months after vitreous surgery, and in 23 healthy control subjects., Results: The mean CFV was significantly reduced in eyes with ERMs compared with healthy controls (p=0.012), and the postoperative mean CFV was significantly increased compared with the preoperative mean CFV (p=0.041)., Conclusion: Significant changes of capillary blood flow velocity in the perifoveal areas were observed between normal subjects and eyes with epiretinal membranes. This indicates that eyes with ERMs show abnormal haemodynamics in the perifoveal capillaries.